Pregnancy Outcome in Lupus Nephropathy

Abstract

The autoimmune disorder systemic lupus erythematosus (SLE) chiefly affects women of childbearing age. Reported incidence figures range from 1 in 660 to 1 in 2952 deliveries. The clinical course of SLE in pregnant women isunpredictable, but the effects of lupus nephritis (LN) on fetal outcomes remain uncertain. The investigators examined maternal and fetal outcomes in 24 patients with LN who had 55 pregnancies over a 15-year period. All the women met American College of Rheumatology revised criteria for SLE and had clinical evidence of LN (proteinuria, nephrotic syndrome, renal insufficiency). Ten had longstanding LN. There were 36 pregnancies in 16 patients in remission (group A) and 19 pregnancies in 8 women with clinically active renal disease at the time of birth (group B). First-trimester spontaneous abortion occurred in 9 group A women (25%). There were 25 live births and 2 stillbirths. More than one fifth of the deliveries were preterm births. Complications included intrauterine growth retardation (11%), pregnancy-induced hypertension in 18.5%, and premature rupture of membranes in 7.4% of group A cases. Eleven of 36 pregnancies resulted in spontaneous term delivery. Approximately one third of group B pregnancies ended in spontaneous abortion. Three of 13 viable deliveries were uncomplicated term births. Chronic hypertension complicated 6 of the 19 group B pregnancies. Four cesarean sections were carried out. There were 3 spontaneous preterm deliveries. Three group B pregnancies were complicated by intrauterine growth retardation; all these mothers were hypertensive. Three stillbirths occurred, and there was I early neonatal death. Overall perinatal mortality was 150 per 1000 deliveries. The mean gestational age of live-born infants in this study was 33.5 weeks, and the mean birth weight was 2.5 kg. Two women had irreversible deterioration of renal function and died. A postpartum flare of clinical LN occurred in 3 group A and 3 group B cases. Two of these 6 women required high-dose steroid therapy. Pregnant women with LN are at high risk of complicated pregnancies and adverse outcomes. Ideally, a rheumatologist and obstetrician/perinatologist who have experience with SLE in pregnancy will follow these patients. Much better outcomes may be expected if LN is controlled before conception.